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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1580581

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1. National Association for Home Care & Hospice Political Action Committee (NAHC PAC)

    NOTE:Commmittee Name is different than previously reported

    228 7th Street SE
    Washington, DC 20003

    NOTE: Address is different than previously reported

    Email: wad@nahc.org;lisa.tignor@us.dlapiper.com

    NOTE: Email address is different than previously reported

2. Date: 04/12/2022

3. FEC Committee ID #: C00188987 This committee is a separate segregated fund. Its connected organization is a Trade Association
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

National Association for Home Care & Hospice
228 7th Street SE
Washington, DC 20003
Affiliated Relationship Code: Connected Organization

Custodian of Records:

William A. Dombi
228 7th Street SE
Washington, DC 20003
Title: Custodian of Records
Phone # (202) 547-7424

Treasurer:

William A. Dombi
228 7th Street SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 547-7424

Designated Agent(s):

Calvin McDaniels
228 7th Street SE
Washington, DC 20003
Title: Assistant Treasurer
Phone # (202) 547-7424

Banks or Depositories

Truist Bank
P.O. Box 305183
Nashville, Tennessee 37230

Signed: William A. Dombi
Date Signed: 04/12/2022

FORM TEXT-1

(End FEC FORM 1)

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